Scope and Span of Stakeholder Control for Health Care Quality and Risk - Development of a Healthcare Integrated Quality and Risk Strategy

Abstract

This research has sought to identify important factors relating to quality patient care and the management of risk in the acute healthcare sector. Key stakeholders including consumers, healthcare workers, health delivery organisations and those involved in the governance of healthservice organisations are part of a critically important continuum of service users and providers, who require and seek to deliver high-quality patient care. The concepts of quality, risk and safety domains are defined within the context of operating complex health organisations that deliver care in a high-risk environment. The aim of this research was to ascertain important elements and actions of key stakeholder groups and organisations in relation to quality and risk and to propose ways of engaging on identified interaction points to enhance the impact of management of quality and risk for healthcare outcomes. The purpose of this research was to identify where changes in practice and operations could enhance the understanding of quality and risk factors and improve their management. Moreover, this research aimed to identify areas of interdependence across the stakeholder continuum that might be positively exploited to improve and enhance patient care outcomes. Four specific research projects have been completed. Original data and information were collected through a national telephone survey of consumers and semi-structured interviews involving current directors of governing health boards. Also analysed were secondary data related to healthcare worker job satisfaction in a complex health organisation, and accreditation survey reports for hospitals and health facilities. In all studies, key themes were identified and interpretations of results were formed into journal article manuscripts submitted to peer-reviewed journals. Consumers, as current, past or potential patients, identified that an assessment of healthcare providers’ reputation and capacity for strong, effective interpersonal engagement were important attributes when considering where to seek care and services. Communication was paramount, both in terms of individual connection and in obtaining and synthesising information about prospective service provision. Some 20% of consumer respondents indicated that they did not know of or use definitions of quality in their review of healthcare services. Healthcare workers identified key job connection and occupational and personal support requirements as contributors to quality patient care and service and system quality activities in their organisations. Team and inter-teamwork were identified as areas that, in addition to their own engagement, needed strong, authentic and transparent leadership to facilitate high-quality care outcomes. Health organisations that establish clear strategic direction, including quality, risk and safety continuum with demonstrable outcome requirements, realised objectives in relation to quality and risk management. Proportionate datamanagement systems were also key to enabling stronger evidence-based practice for quality and risk management in health organisations. At the governance level, goals and objectives promoting a deep cultural understanding and widespread dissemination of quality and risk management factors at all levels of the organisation were identified as important responsibilities for health boards. Similarly, governance responsibility around development and implementation of proportionate, effective quality and risk management structures and systems was identified as a key objective for the governance level and functions in health organisations. Specific support and improvement opportunities have been identified, such as provision of curated information on quality and risk to consumers; development of deep learning in healthcare organisations regarding impact and improvement opportunities resulting from enhanced approaches to quality and risk management; enabling of deep learning around quality and risk management; and strong, authentic and transparent leadership for developing strategies to enable high-quality patient care. In addition, a theory and model about the Healthcare Integrated Quality and Risk Strategy has been developed aimed at engaging critical enablers and capitalising on the interdependence of stakeholder groups in the attainment of high-quality patient care outcomes.